Patient Information
A 38-year-old male presented to the ophthalmology clinic with a 10-day history of bilateral blurred vision, accompanied by recent onset headaches and auditory disturbances. He reported no prior ocular trauma or infections. His past medical history was unremarkable, and there was no family history of autoimmune or inflammatory diseases. On systemic examination, no rash or skin depigmentation was noted at presentation.
Diagnosis
Ophthalmic examination revealed bilateral granulomatous anterior uveitis and multiple serous retinal detachments on fundoscopy. Optical coherence tomography (OCT) confirmed subretinal fluid. Neurological evaluation noted mild sensorineural hearing loss, and brain MRI demonstrated nonspecific meningeal enhancement. Based on clinical features including bilateral panuveitis, neurological symptoms, and auditory involvement, the diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was established. This multisystem autoimmune disorder targets melanocyte-rich tissues including the eyes, inner ear, and meninges.
Differential Diagnosis
Differential considerations included:
– Sympathetic ophthalmia: typically follows ocular trauma or surgery, which was absent.
– Multiple sclerosis: neurological symptoms present but ophthalmic findings and auditory symptoms were atypical.
– Sarcoidosis: can cause uveitis and neurological symptoms but chest imaging and serum ACE levels were normal.
– Infectious causes (e.g., syphilis, tuberculosis): infectious workup including serologies was negative.
